Critical-care transport team improves care

When a 2-week-old infant was rushed to the ED at Loma Linda (CA) University Medical Center with injuries from a motor vehicle accident, the facility’s critical-care transport nurse noted that the infant was only minimally responsive to stimuli, even needle sticks.

As a result of the nurse’s suggestion, in collaboration with the resident and attending physician, a decision was made to obtain a head computerized tomography (CT) scan immediately, instead of waiting until the morning, recalls Sharon Pearson, RN, the facility’s critical-care transport manager. "The CT did show blood, and this probably would not have shown up on an ultrasound," Pearson says. "There could have been a negative outcome if the CT had not been obtained in such a timely manner."

Transport team fills a vital role

That scenario illustrates the important role that a critical-care transport team plays in the facility’s ED, she says. The team transports critically ill, monitored, and sedated patients for appropriate diagnostic procedures and provides 24-hour coverage with one to eight nurses.

Here are several benefits of the critical care transport team:

• Patient flow is improved. Nurses don’t have to cover for a colleague while he or she transports a patient, says Jennifer Dearman, RN, nurse manager for emergency services. "Since the ED can maintain our own staff, patients can be seen more quickly," she says. Transporting patients for tests can take a nurse out of the ED for several hours, because of the need to bring the patient to several diagnostic areas, Pearson says. For example, a trauma patient first will be taken for CT scans of the head, abdomen, and pelvis. "We have recently started doing CT scans of the c-spine from the base of the skull to the pedicle of T1 or T2," Pearson says. "If the chest X-ray is at all suspicious, we will also get a chest CT."

In addition, the patient will be taken for magnetic resonance imaging if there is any question of a spinal-cord injury, she says. "When all the primary studies are completed, we will get the completed spine films and transfer the patient to the ICU [intensive care unit]," Pearson points out.

• Continuity of care is improved. The team is activated to the ED to assist during all traumas. "All the while, they are learning about the patient that they will accompany to CT," says Dearman. "This is good for continuity of patient care." Transport nurses pitch in with procedures such as putting in Foley catheters, nasogastric tubes, and intravenous lines. "They are present while the patient is being worked up, so they are aware of any problems identified during the course in the ED," Dearman says. They also are involved in the medication and/or sedation of the patient while in the ED, which is helpful during transport, she adds. "They would also be able to give a much more comprehensive report to the inpatient unit receiving the patient, because they have been a part of the treatment from the beginning," Dearman says.

• Adverse outcomes are avoided. The team is made up of highly experienced critical care nurses, with a minimum of three years of ICU or ED experience required, says Dearman. "Their level of assessment skills, clinical judgment, and critical thinking helps prevent adverse outcomes," she says.

If a patient’s condition deteriorates during transport, the team is ready to handle this change and has all the equipment and supplies ready at a moment’s notice, Pearson says. "Our advantage is our training and experience is in the transport environment," she points out. "We know all the potential things that can occur, we know who to delegate things to and how to get the necessary help if we need it for a safe transport without negative outcomes."

She recalls that after a 20-year-old man was intubated, sedated, and given a paralytic, the head CT scan showed an epidural bleed with shift. Although the patient’s pupils had been equal and reactive, the transport nurse noticed that now one pupil was dilating and only sluggishly reactive. "The neurosurgeon ordered mannitol and 3% normal saline, which we had with us, so we were able to administer this immediately," says Pearson.

• Costs are saved. ED managers from other facilities have contacted Pearson and expressed a desire to implement a critical-care transport team, but they face a specific obstacle. "The roadblock has always been that administration wants to see a revenue producer," she says. "You can’t really demonstrate a revenue, but you can show a cost savings."

Reducing liability risks

For example, Pearson says that liability risks are significantly lower because of the team’s expertise in the transport environment. "Avoiding even one potential lawsuit more than pays for our team," she says. Also, the transport nurses are cross-trained to help out in the ED and other departments, she says. "So, we get maximum productivity out of them," she says.

The team helps out with inpatients being held waiting for beds, Pearson says. "If we know the ED is getting hit really hard, we will go with the patient to wait until a bed is staffed for us," she says.

Sources

For more information on the benefits of a critical-care transport team, contact:

Jennifer Dearman, RN, Nurse Manager, Emergency Services, Loma Linda University Medical Center & Children’s Hospital, 11234 Anderson St., Loma Linda, CA 92354. Telephone: (909) 558-7375. Fax: (909) 558 4641. E-mail: JSDearman@ahs.llumc.edu.

Sharon Pearson, RN, Critical Care Transport Manager, Loma Linda University Medical Center & Children’s Hospital, 11234 Anderson St., No. 1185, Loma Linda, CA 92354. Telephone: (909) 558-8601. Fax: (909) 558-0123. E-mail: SPearson@ahs.llumc.edu.